Expert second opinion for dementia and neurodegenerative conditions
Radiology Prime provides independent specialist neuroradiology second opinions on brain MRI for dementia, small vessel disease, and related neurodegenerative conditions.
Reports are personally prepared within 24 hours by our Clinical Lead, a European-registered consultant neuroradiologist, applying MTA, GCA, Koedam, and Fazekas visual rating scales to give your treating physician a structured framework alongside cognitive symptoms.
Why dementia imaging is rarely clear-cut
Brain MRI findings in cognitive change are rarely black and white. Normal ageing, small vessel disease (blood vessel changes in the brain), and neurodegenerative conditions like Alzheimer’s can look similar on a scan at first glance.
The useful question is usually not whether the scan shows changes, but whether the pattern matches what’s expected for the person’s age — and how much of the picture is vascular rather than neurodegenerative.
Applying structured scoring scales gives your memory clinic team precise, reproducible measurements rather than a general impression.
Why get an independent dementia second opinion?
Families and patients often seek a second opinion at specific moments — when a memory clinic MRI has been described in general terms and you want a clearer, scored assessment; when it’s unclear how much of the picture is vascular change versus neurodegenerative disease; when younger-onset symptoms raise questions about which type of dementia is most likely; or when newer treatments are being considered and require precise baseline measurements. The report is designed to be read directly by the memory clinic team alongside the cognitive assessment.
Independent perspective
The way a brain MRI is described can depend on whether specific scoring scales were applied and on whether prior scans were available for comparison. An independent sub-specialty review gives you a second, structured read — with scored measurements and pattern-based discussion — framed for your memory clinic team.
Sub-specialty expertise
Dementia and small vessel disease are a core part of our Clinical Lead’s neuroradiology practice. Reports apply the four visual rating scales most commonly used in memory clinic imaging — MTA, GCA, Koedam, and Fazekas — together with pattern-based discussion across Alzheimer’s, frontotemporal dementia, Lewy body dementia, and vascular cognitive impairment.
Tracking change over time
Cognitive change usually unfolds over years, not weeks. When earlier scans are available, our Clinical Lead reviews them side-by-side with the most recent one, applying the same scoring scales each time, so that change is measured consistently rather than described in general terms.
How it works
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Expert radiologist review
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Common challenges in dementia imaging
An independent review by our Clinical Lead gives the memory clinic team scored measurements of brain shrinkage and blood vessel changes, along with a discussion of which patterns are most consistent with which conditions. Each of the common interpretive challenges below is handled through that same structured approach.
Telling Alzheimer’s pattern from normal ageing
The challenge: The memory areas of the brain shrink a little in everyone as they age. The question is whether the shrinkage is more than expected for the person’s age.
The reality: The MTA (medial temporal atrophy) scale gives a reproducible 0–4 score for shrinkage in the memory-forming areas of the brain, read against age-adjusted expectations. When MTA scoring is combined with the Koedam scale for the back of the brain, the pattern as a whole can be compared against what’s typical of Alzheimer’s disease.
What our review adds: Structured MTA and Koedam scores, explained in the context of the person’s age, to support a clearer conversation with the memory clinic team about whether the pattern favours a neurodegenerative process or normal ageing.
Telling Alzheimer’s apart from frontotemporal dementia
The challenge: Alzheimer’s disease and frontotemporal dementia (FTD) can look similar clinically, particularly in younger patients, and the MRI pattern is an important part of telling them apart.
The reality: FTD tends to show shrinkage in the front and front-sides of the brain, with the memory areas relatively preserved — the opposite of the typical Alzheimer’s pattern. Scoring atrophy region by region using the GCA (global cortical atrophy) scale alongside MTA gives a structured picture that helps support the differential.
What our review adds: Region-by-region GCA and MTA scoring, with a discussion of which pattern the imaging is most consistent with, to inform the memory clinic team’s assessment.
Weighing vascular versus neurodegenerative contribution
The challenge: Many people with cognitive symptoms have both neurodegenerative changes and small vessel disease on their MRI. Understanding how much each is contributing matters for management and prognosis.
The reality: The Fazekas scale gives a 0–3 score for white matter changes — the fingerprint of small vessel disease — in both the deep parts of the brain and the areas near the fluid-filled ventricles. Counts of lacunes (small strokes) and microbleeds add further structured measures of vascular burden.
What our review adds: Fazekas scoring, lacune count, and microbleed characterisation alongside atrophy scoring, so the vascular and neurodegenerative pictures are each described with their own measurements rather than discussed in general terms.
Looking for treatable conditions that can mimic dementia
The challenge: A small number of conditions that can cause symptoms similar to dementia are potentially treatable — and a focused imaging review is an important part of the workup.
The reality: Normal pressure hydrocephalus (a condition where the brain’s fluid-filled spaces enlarge and cause gait, memory, and continence symptoms), chronic subdural collections (old, slow blood collections around the brain), and other structural conditions each have recognisable imaging features.
What our review adds: A targeted look for these conditions, with scored measurements where relevant. Where features of a treatable condition are identified, the report explicitly recommends prompt discussion with the treating physician, because the management pathway differs substantially from primary neurodegenerative disease.
View a Sample Neuroradiology Report
Transparency is key to trust. View a redacted sample of an second opinion report. In this case, the MRI findings were interpreted as more consistent with a non-demyelinating process rather than active multiple sclerosis.
Conditions reviewed by our Clinical Lead
Patients and families often seek a second opinion for these specific situations:
Alzheimer’s disease and related presentations
Typical Alzheimer’s pattern: Scored MTA and Koedam assessment of memory and posterior brain areas to characterise the pattern of atrophy.
Visuospatial presentations (posterior cortical atrophy): Focused Koedam scoring of the back of the brain in patients whose symptoms started with visual or spatial difficulties rather than memory loss.
Language-led presentations: Assessment of language-area atrophy alongside standard scoring for patients whose symptoms began with word-finding or speech difficulties.
Baseline scan for new Alzheimer’s treatments: Pre-treatment measurement of atrophy, white matter changes, and microbleed count, to support eligibility discussions with the treating physician.
Other neurodegenerative conditions
Frontotemporal dementia (FTD): Regional GCA scoring focused on the front and front-sides of the brain, with discussion of how the pattern compares with typical Alzheimer’s disease.
Lewy body dementia: Review of imaging features, including relatively preserved memory areas, which may be more consistent with Lewy body dementia than with typical Alzheimer’s on structural MRI.
Parkinson-plus conditions: Review of asymmetric cortical changes, midbrain measurements, and related features in patients with suspected corticobasal syndrome or progressive supranuclear palsy.
Younger-onset cognitive decline: Focused review in patients under sixty-five, with attention to pattern-based differential across typical and atypical conditions.
Small vessel disease and vascular cognitive impairment
Fazekas scoring for white matter changes: Structured 0–3 scoring of white matter changes in both the deep and periventricular regions, the most common marker of small vessel disease.
Lacune and microbleed assessment: Counts and distribution of small strokes and microbleeds on dedicated MRI sequences.
Cerebral amyloid angiopathy features: Assessment of microbleed distribution and cortical surface deposits — a pattern sometimes seen in older patients, particularly relevant before starting blood-thinning medications.
Mixed vascular and neurodegenerative picture: Combined atrophy scoring and vascular burden characterisation when both pictures are present, so each is described with its own measurements.
Treatable conditions and structural mimics
Normal pressure hydrocephalus: Targeted measurements (Evans index, callosal angle, DESH pattern) in patients with the combination of gait, memory, and continence symptoms.
Chronic subdural collections: Focused review for old blood collections around the brain that may contribute to cognitive symptoms.
Structural lesions that can mimic dementia: Review for tumours, cysts, or other structural findings that can present with memory or behaviour change.
Cognitive symptoms after head injury or stroke: Structured review of imaging in patients whose cognitive symptoms began after a head injury or cerebrovascular event.
Frequently asked questions
A second-opinion radiology report is an additional input into the workup, not a diagnosis in itself. Our Clinical Lead applies MTA, GCA, Koedam, and Fazekas visual rating scales to the brain MRI and provides an independent structured opinion on the pattern of atrophy and the vascular picture. The diagnosis rests with the treating physician or memory clinic team, who considers the imaging alongside cognitive testing, medical history, blood tests, and where appropriate further investigations. The report is designed to make that conversation sharper and more specific.
Yes — the report is intended to be shared with your neurologist. It is structured for peer-to-peer clinical use, with specific framework citations (McDonald, MAGNIMS) and cross-referenceable findings, alongside a plain-language summary for patients. The radiology report is personally signed by our Clinical Lead under her full name and credentials, as any hospital-generated radiology report would be. We encourage you to share it directly with your neurology team.
No. In most regions, patients may independently request a radiology second opinion.
Our service provides an independent subspecialty radiology review of your existing MRI or CT imaging. This evaluation is designed to support and not replace your treating physician’s clinical assessment.
We encourage discussing your second-opinion report with your doctor to determine the most appropriate next steps.
No. Patients can request a neuro-oncology second opinion directly, without a referral from their treating physician. We do recommend that you share the report with your treating team afterwards, because the report is designed to support your clinical discussion rather than to stand alone.
Our technical support team can assist if you experience difficulty uploading your images. The website chat feature is available to help answer technical questions during the submission process.
Follow-up questions are welcome after your report is delivered. If clarification is needed, you may submit questions to the radiologist who performed your review. This process is designed to help address outstanding points and support discussion with your treating physician.
You receive a detailed review of your MRI or CT scan prepared by experienced European radiologists. Beyond listing findings, the report explains how the imaging observations relate to the clinical information you provide. Each report follows established radiology standards and includes a clear summary to support discussion with your treating physician.
The report is layered for two audiences: a sub-specialty radiology section written for your treating physician, and a plain-language summary section written for you. Clinical terminology is used where accuracy requires it, but the patient summary makes the key points accessible. If any part of the report raises questions, those are exactly the questions to bring to your treating physician.
We provide a comprehensive clinical report written for your treating physicians, along with a clear plain-language summary. This approach is designed to help you better understand the reasoning behind the imaging findings while supporting discussion with your doctor.